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Introduction: Acute scrotum is a frequent reason for consultation in paediatric surgical emergencies, spermatic cord torsion is the diagnosis that is feared by all surgeons which induces surgical exploration. The aim of our study is to determine the diagnostic elements that can differentiate a spermatic cord torsion from other scrotal pathologies.
Patients&methods: It is a 3-year retrospective study at Constantine's paediatric surgery department from January 2016 to December 2018.We included all patients hospitalized for an acute scrotum. Khi square and T Student statistical tests were used, and 5% p value threshold of significance is fixed.
Results: 145 boys were hospitalized for acute scrotum; the mean age was 8,54 +/- 5,06 years [7 hours-14 years] (N=145). We distributed this patient after surgical exploration in two groups, the group 1 (45 boys) contains patients with spermatic cord torsion and the group 2 (100 boys) contains patients with other scrotal diagnosis (N=145). Anamnestic factors are: age (p=0,309), history of cryptorchidism(p=0,139), history of recent infection(p=0,240) and of inguino-scrotal surgery(p=0,687), scrotal traumatism(p=0,042) with less torsions in case of traumatism, and evolution time (p=0,680). The main clinical findings are: the side (p=0,069), scrotal volume (p=0,015, Prehn sign (p=0,857), and thickness of the spermatic cord (p<0.001). Echographic findings were the testicular volume p<0.001), echogenicity(p<0.001), Doppler testicular (p<0.001), epididymal volume (p=0,132), epididymal echogenicity(p=0,019), visualization of spermatic cord torsion (p=0,003) and conclusion of the echo doppler (p<0.001). Sensibility of echography was 75,8% and specificity was 81,3%.
Conclusion: Few anamnestic and clinical elements can help surgeons to decide to explore. Even if echographic findings are significantly different between the two groups, we cannot recommend systematic use of this exam because of the high rate of false negatives and false positives.